Posterior heel pain is a fairly common affliction affecting a large number of individuals at least at some time in their lives to varying degrees. There are three accepted common causes of posterior heel pain known to the medical profession as (1) Haglund syndrome (pump bump deformity), (2) Achilles tendonitis and (3) Sever's disease.
Haglund syndrome is characterized by a painful soft tissue swelling at the Achilles tendon insertion, that is, the point of attachment of the tendon to the bone of the heel. In many cases, a bony deposit may develop on the back of the heel. A possible additional symptom of Haglund syndrome is inflammation of the bursa, a fluid-filled sac that decreases friction between the Achilles tendon and the heel, a condition known as retrocalcaneal bursitis. The Achilles tendon itself may also thicken and the soft tissue overlying the tendon may actually bulge.
It is believed that Haglund's syndrome results from the repetitive application of trauma or stress to the heel. Certain stiff, low-backed shoes, such as low-top tennis shoes, may contribute to the problem in particular individuals.
Common treatments for Haglund syndrome include the use of heel lifts (foam pads of approximately 0.25 inches in thickness), oral pain relievers and various physical therapy treatments and flexibility exercises. Surgical procedures may also be utilized in more severe cases. These surgical procedures include: the diagonal removal of heel bone known as oblique calcaneal osteotomy; removal of the deep and superficial retrocalcaneal bursae; and cleaning and tendon repair.
Achilles tendonitis is responsible for about 20% of the foot and ankle problems suffered by runners. There appear to be two types of Achilles tendonitis. One affects the tendon where it connects to the heel bone. The other affects the musculotendonous junction. The affliction is characterized by soft tissue swelling, tenderness to the touch and roughening about the tendon known as crepitus. There is also pain with active pointing and passive raising of the foot.
A number of problems are believed to cause Achilles tendonitis. These include the application of abnormal mechanical longitudinal stress on the tendon, poor flexibility and overuse and/or overload.
Common treatments for Achilles tendonitis include rest, the use of heel lifts or shoe inserts, anti-inflammatory medications as well as various physical therapy treatments and exercises.
Sever's disease was first described in 1912 as resulting from a sclerosis or thickening and irregularity of the growth plate known as the calcaneal apophysis. Presently, it is believed the condition results from inflammation of the soft tissues of the heel following an injury. Sever's disease may result in a number of conditions including retrocalcaneal bursitis (described above), traction apophysitis (i.e. pulling of tendon away from bone) and osteochondrosis of the calcaneal apophysis (irritation and inflammation of bone and cartilage in the heel).
The condition is fairly common in boys from 8-15 years of age. It is characterized by pain down the back of the heel, pain with either passive raising of the foot or a rapid, repetitive pointing of the foot, and a spring gait. Running and jumping aggravate the condition.
Common treatments for Sever's disease include rest, various physical therapy treatments (excluding ultrasound), flexibility exercises and heel lifts.
With any of these ailments, the utilization of more conservative treatment methods is preferred. Thus, heel lifts, rest and specific exercises to increase flexibility are often prescribed. While these methods and techniques are effective for many individuals, they are ineffective for a significant number of others for a number of reasons.
While heel lifts relieve pain symptoms by raising the heel and shortening the length of the Achilles tendon, they do not fully address the causative factors of the ailments. Thus, successful treatment with heel lifts usually requires sufficient rest. Many physically active people suffering from, for example, Achilles tendonitis simply do not allow for the necessary rest. Others simply find the heel lifts inconvenient and uncomfortable and do not use them as prescribed. Thus, recovery is slowed. A need is, therefore, identified for an improved and more efficient, conservative treatment for the causes of posterior heel pain.